Take Our “Quiz”: Obamacare at the Supreme Court

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Somebody has leaked to us the entrance exam for the ultra-prestigious ACME School of Public Health, designed to determine whether applicants can reason through challenging public health dilemmas:

You are an aspiring health czar for the nation, and listed below are facts for you to consider and then two potential courses of action for you to choose.

1. There is a virus called the human immunodeficiency virus (HIV) that once killed almost everyone who contracted it, but now there is a course of treatment that is remarkably effective and allows almost all people adherent to it to live healthy, normal lives. Should you:

A. Make health insurance covering this treatment affordable to the residents of less than one third of the states, OR

B. Make health insurance covering this treatment equally affordable to the residents of every state.

2. Despite this miraculous treatment, there are certain racial/ethnic groups that—though engaging in no more risk behaviors than other groups—experience significantly higher rates of infection and, if infected, worse health outcomes, including higher death rates. Should you:

A. Make health insurance more affordable only in states where a small subset of people of those racial/ethnic backgrounds live, OR

B. Make health insurance covering this treatment more affordable to the residents of every state.

3. Not only does the treatment prolong and improve the lives of the people living with HIV, it also renders them almost non-infectious, reducing the risk of transmission to near zero. Should you:

A. Make health insurance covering this treatment affordable to the residents of less than one third of the states, OR

B. Make health insurance covering this treatment equally affordable to the residents of every state.

4. Until recently, there was no medication that could be used by someone at higher risk of infection to prevent acquisition of the virus; now there is an amazingly effective pharmaceutical course of treatment for that purpose. Should you:

A. Make health insurance covering this prevention regimen affordable to about one third of the states, OR

B. Make health insurance covering this prevention regimen equally affordable to the residents of every state

If you answered “B” to every question, congratulations, you passed with flying colors and have a solid grasp of the role that access to health insurance and health care plays in promoting public health. And you should be very concerned that in King v. Burwell, the latest challenge to Obamacare, the Supreme Court is being asked to render a decision that effectively will answer “A” to all of the above questions, thus fueling an already urgent public health crisis to catastrophic proportions within certain communities. Certainly, this is not at all what Congress intended in passing the Patient Protection and Affordable Care Act (ACA).

In an effort to help prevent this outcome, Lambda Legal filed a friend-of-the-court brief focusing on the disparate impact that an adverse decision will have on people of color living with HIV—particularly lower-income Black and Latino people—in states, many across the South, that have elected not to run their own health insurance exchange. We brought to the Court’s attention the public health crisis bordering on an emergency within impacted communities, and provided a legal framework through which this information may be taken into account in making this important decision.

As a country, we have at our disposal the financial and medical resources we need to reduce dramatically new HIV infections and to eliminate AIDS-related deaths in the United States—and frankly, it is unconscionable that we have not yet done so. With Obamacare, we have taken an important step toward mobilizing those resources and making them accessible to the hardest to reach and most marginalized people living with and at highest risk for HIV. Here’s hoping the Supreme Court lends its ear to the voices of those people, has an eye toward improving public health for all communities, and “passes” this test in a way that allows the country to continue to move forward toward healthier lives for everyone.

This brief allows the Supreme Court to hear the voices of those people when considering the crucial questions as to what Congress intended and how to avoid an absurd result in interpreting this statute; we hope the Court “passes” this test in a way that allows the country to continue to move forward toward healthier lives for everyone. To learn more about the brief Lambda Legal filed, click here.